Abstract
Purpose: :
To report the long–term visual outcomes of surgical removal of extensive peripapillary choroidal neovascularization (PPCNV) associated with presumed ocular histoplasmosis syndrome (POHS).
Methods: :
The medical records of patients who underwent surgical removal of extensive PPCNV associated with POHS at the Barnes Retina Institute (St. Louis, Missouri) between May 1992 and December 2003 were reviewed. 40 consecutive eyes (in 35 patients) with >12 months of follow–up were included in this retrospective review. All eyes were ineligible for laser treatment by MPS criteria.
Results: :
The PPCNV was subfoveal in 23 of 40 eyes and extrafoveal in 17 eyes. Patient age ranged from 5–73 years (median 34.5 years). Follow–up ranged from 14–139 months (median 61 months). In eyes with subfoveal CNV, preoperative best–corrected Snellen visual acuity (BCVA) ranged from counting fingers at 2 feet (CF) to 20/25–2 (median 20/200). Final BCVA ranged from CF to 20/15 (median 20/50). Of 23 eyes, 18 achieved stable or >2 lines improvement in BCVA from preoperative to final postoperative exam; only 5 eyes had >2 lines decrease in BCVA. Overall, 10 of 23 eyes achieved 20/40 BCVA at the final postoperative exam.
In eyes with extrafoveal CNV, preoperative BCVA ranged from 20/300 to 20/20 (median 20/60). Final BCVA ranged from 20/200 to 20/20 (median 20/20–1). Of 17 eyes, 15 achieved stable or >2 lines improvement in BCVA from preoperative to final exam; only 2 eyes had >2 lines decrease in BCVA. Overall 14 of 17 eyes achieved 20/40 BCVA at the final postoperative exam.
Conclusions: :
Surgical removal may provide visual benefit in selected cases of extensive PPCNV associated with POHS.
Keywords: vitreoretinal surgery • choroid: neovascularization • fungal disease